1. ANEMIA OF CHRONIC DISEASE (ACD)
This is another option for an Overview slides using transitions.
Fify Henrika
Clininal Pathology Department of FKUI
Module Hematoloy & Onkology
September 2, 2014

2. IRON PROTOPORPHYRIN + IRON DEFICIENCY SIDEROBLASTIC ANEMIA
HAEM
GLOBIN
HAEMOGLOBIN
SIDEROBLASTIC ANEMIA
IRON DEFICIENCY
CHRONIC INFLAMMATION/
MALIGNANCY +
THALASSEMIA
(Α OR Β)

3. ANEMIA OF CHRONIC DISEASE (ACD)
ONE OF THE MOST COMMON ANEMIA OCCUR IN PATIENTS:
CHRONIC INFLAMMATORY
CHRONIC INFECTION
TRAUMA
MALIGNANCY
RENAL, HEPATIC AND EDOCRINOLOGICAL DISEASES ARE NOT CONSISTENTLY ASSOCIATED WITH ABNORMALITIES OF IRON METABOLISM SEEN IN ACD

4. Inhibits iron absorption
PATHOGENESIS
ANEMIA IS ASSOSIATED WITH DECREASED IRON RELEASE FROM MACROPHAGE TO PLASMA
REDUCED RBC LIFESPAN
IN ADEQUATE IT ERYTHROPOIETIN RESPONSE TO ANEMIA, CAUSE BY CYTOKINE EFFECTS SUCH IL-1, TNF ON ERYTHROPOIESIS
HEPCIDIN RELEASED BY THE LIVER IN RESPONSE TO INFLAMMATION
Inhibits macrophage release of iron
Inhibits iron absorption

5. CAUSES OF THE ANEMIA OF CHRONIC DISEASES (ACD)
CHRONIC INFLAMMATORY DISEASES
INFECTIONS (E.G. PULMONARY ABSCESS, TUBERCULOSIS, OSTEOMYELITIS, PNEUMONIA, BACTERIAL ENDOCARDITIS)
NON-INFECTIONS (E.G. RHEUMATOID ARTHRITIS, SYSTEMIC LUPUS ERYTHEMATOSUS AND OTHER CONNECTIVE TISSUE DISEASE, SARCOIDOSIS, CROHN’S DISEASE
MALIGNANT DISEASES
CARCINOMA, LYMPHOMA, SARCOMA
Hoffbrand AV, Moss PAH, Pettit JE. Essential haematology .5th ed. Oxford : Blackwell Publishing; 2006.p.39.

6. INVESTIGATION OF A HYPOCHROMIC MICROCYTIC ANAEMIA
MCV  / MCH 
BLOOD FILM
SERUM IRON
SERUM IRON 
SERUM IRON 
SERUM IRON N /
FERRITIN LEVEL
MARROW FOR IRON
HAEMOGLOBIN STUDIES : Hb F/ HbA2
FERRITIN 
FERRITIN N / 
THALASSAEMIA, ABNORMAL HAEMOGLOBIN
SIDEROBLASTIC ANAEMIA
IRON DEFICIENCY
ANAEMIA OF CHRONIC DISORDER
Lewis SM, Bain BJ, Bates I. Dacie and Lewis practical haematology. 9th ed. London : Churchill Livingstone; 2001.p.582.

7. LABORATORY FINDINGS (1)
HYPOFERREMIA
NORMOCHROMIC NORMOCYTIC ANEMIA, RARELY HYPOCHROMIC MICROCYTIC ANEMIA
SERUM IRON ↓, TIBC ↓, SATURATION INDEX <15%
BM IRON STORES NORMAL OR ↑, SERUM FERRITIN NORMAL OR ↑
REDUCED BM SIDEROBLASTIC IRON BECAUSE REDUCED SUPPLY OF IRON TO THE MARROW ERYTHROCYTE

8. LABORATORY FINDINGS (2)
Accumulation of iron-containing granules in normoblasts
(Pearls’ reaction)

9. LABORATORY FINDINGS (3)
Abnormal plasma protein  acute phase response
Erythrocyte sedimentation rate (ESR) increased
IL-1 + OTHER MEDIATORS OF INFLAMMATION
(Protein synthesis)
MACROPHAGE
HEPATOCYTE
↑ COMPLEMENT
↑ FERRITIN
↑ PHAGOCYTIC ACTIVITY
↑ IL-1
↑ ACUTE-PHASE REACTANS
↓ ALBUMIN
↓ TRANSFERRIN (TIBC)
↑ CRP

10. The role of lactoferrin in causing hypoferremia
This is another option for an Overview slides using transitions.

11. LABORATORY DIAGNOSIS OF HYPOCHROMIC ANAEMIA
IRON DEFICIENCY
CHRONIC INFLAMMATORY OR MALIGNANCY
MCV
MCH
Reduced in relation to severity of anaemia
Normal or mild reduction
Serum iron
Reduced
TIBC
Raised
Serum transferrin receptor
Normal/low
Serum ferritin
Normal or raised
Bone marrow iron stores
Absent
Present
Erythroblast iron
Hoffbrand AV, Moss PAH, Pettit JE. Essential haematology .5th ed. Oxford : Blackwell Publishing; 2006.p.39.

12. TREATMENT IRON THERAPY AND HEMATINIC AGENT ARE UNNECESSARY
RESOLVE THE UNDERLYING INFLAMMATORY OR INFECTIOUS PROCESS SUCCESSFULLY TREATED
ANEMIA WILL IMPROVE WITH EFFECTIVE CHEMOTHERAPY FOR MALIGNANT DISEASE
THE ANEMIA RESPONSE TO ERYTHROPOIETIN IN ACD

13. THANK YOU